An 11-yr-old male with pneumonia and persistent airway obstruction.

At the age of 4 yrs the male child suffered from a Wilms-tumour of the right kidney treated by polychemotherapy (SIOP No. 9 for stage 1 using actinomycin and vincristin) and surgical removal. A year later, abdominal pain occurred and a local relapse of the Wilms-tumour was diagnosed. Further diagnostics revealed infiltration into the liver, diaphragm, and the thoracic wall. In addition, three lung metastases were found. The child received polychemotherapy again (according to protocol SIOP 93/01 for stage 4 using adriamycin, etoposide, carboplatin, ifosphamide) and radiotherapy of the lung, abdomen (15 Gray) and of the tumour site (35 Gray). The tumour could be resected. All follow-ups during the next 6 yrs showed remission and the child was healthy. At the age of 11 yrs, he presented with fever and cough. The chest radiograph showed an opacity of the left upper field (fig. 1). Under the suspicion of pneumonia, antibiotic treatment was started. Due to bronchial obstruction, the child received low-dose inhaled steroids and b-adrenergic agents. Nonetheless, he still suffered from bronchial obstruction and intermittent fever. Pulmonary function measurement revealed a mixed restrictive and obstructive ventilation disorder (forced vital capacity 52%, forced expiratory volume in one second 49% and flow at 25% vital capacity 13% predicted). Computed tomography (CT) scan of the thorax (including radioopaque material) was performed (fig. 2). For further diagnosis flexible bronchoscopy was performed, revealing a ball-shaped, soft, solid tumour deriving from the left upper lobe bronchus and bulging into the ostium of the left main bronchus (fig. 3). In order to obtain a thorough diagnosis of the tumour, thoracic surgical intervention was performed. The histology of the tumour revealed typical findings (fig. 4).